ConnectiCare now has three lines of business; commercial (employer group), Marketplace (individual on and off-Exchange), and Medicare plans.
Commercial plan members have an ID number that begins with the letter “K.” For these members, providers should:
- Use our existing portal to conduct various online functions including request prior authorization, verify eligibility, access benefits and claims information, and facilitate dispute resolution.
- Submit claims according to the Claims Submission section under the Commercial tab on Billing & Claims page.
- Refer to the Vendor-Managed Utilization Management Programs page for respective vendor contact information.
- Follow the policies under the Commercial tab on the Medical Coverage Criteria page, the Pharmacy Policy Criteria page, and the Enterprise Pharmacy Medical Policies page.
- Refer to the Join Our Network page for credentialing and recredentialing information.
Marketplace plan members have an all-numeric ID number with 3–9 digits. For these members, providers should:
- Use the new Availity Essentials portal to conduct various online functions including request prior authorization, verify eligibility, access benefits and claims information, and facilitate dispute resolution.
- Submit claims as outlined in the 2026 Marketplace Provider Manual.
- Refer to the Vendor-Managed Utilization Management Programs page for respective vendor contact information.
- Follow the policies on the Medical Oncology Policies page, and under the Marketplace tab on the Medical Coverage Criteria, Pharmacy Policy Criteria, and Enterprise Pharmacy Medical Policies pages.
- Refer to the Join Our Network page for credentialing and recredentialing information.
Medicare plan members have an ID number that either begins with the letter “K” or an all-numeric ID number with 13 digits that begins with the number eight. For these members, providers should:
- Use the new Availity Essentials portal to conduct various online functions including request prior authorization, verify eligibility, access benefits and claims information, and facilitate dispute resolution.
- Submit claims as outlined in the 2026 Medicare Provider Manual.
- Refer to the Vendor-Managed Utilization Management Programs page for respective vendor contact information.
- Follow the policies on the Medical Oncology Policies page, and under the Medicare tab on the Medical Coverage Criteria, Pharmacy Policy Criteria, and Enterprise Pharmacy Medical Policies pages.
- Refer to the Join Our Networkpage for credentialing and recredentialing information.
